Registered nurse - degree (NMC 2018)

Overview of the role

Giving care, advice and support to sick, injured or disabled people.

Reference Number: ST0781

Details of standard

Occupation summary

This occupation is found in every sector. Registered nurses work in the public, independent and voluntary sector. Registered nurses are a statutorily regulated profession and the standards for proficiency are set by the Nursing and Midwifery Council (NMC) and successful completion of this apprenticeship will meet the education requirements to see registration with the NMC. This standard covers the NMC Standards for Proficiency and Annexes A & B for registered nurses (May 2018) and covers the four fields of practice that are Adult, Mental Health, Learning Disability and Child.

The broad purpose of the occupation is to play a vital role in providing, leading, coordinating and evaluating care that is compassionate, evidence based, and person centred. They are accountable for their own actions and those who they delegate to and must be able to work autonomously, or as an equal partner with a range of other professionals. They provide nursing care for people across the whole lifespan who could have complex and concurrent mental, physical, cognitive and behavioural care needs and for people at the end of their life.

Registered nurses make an important contribution to the promotion of health, health protection and the prevention of ill health. They do this by empowering people, communities and populations to exercise choice, take control of their own health decisions and behaviours and by supporting people to manage their own care where possible.

In their daily work, an employee in this occupation interacts with a variety of service users, families and carers, and with an extensive range of health and care professionals and other agencies including social services, police, probation, prisons, housing, education, language interpreters and third sector agencies. They will also work with, support and facilitate the learning of a range of learners from across health and care professions. They might be working in a hospital, someone’s home, the community, social care or public health and may work various shift patterns which enable care to be provided 24 hours per day, seven days per week, 365 days of the year. Registered nurses are a key part of the multidisciplinary teams that meet the integrated health and care needs of patients and service users.

An employee in this occupation will be responsible for providing leadership in the delivery of care for people of all ages and from different backgrounds, cultures and beliefs. They must be able to care for people in their own home, in the community or hospital or in any health care settings where their needs are supported and managed. All registered nurses work as part of a team but on a day to day basis may be working alone when seeing people in their own homes or in the community. They work in the context of continual change, challenging environments, different models of care delivery, an older and more diverse population, innovation and rapidly evolving technologies. Increasing integration of health and social care services will require registered nurses to negotiate boundaries and play a proactive role in multidisciplinary teams. The confidence and ability to think critically, apply knowledge and skills and provide expert, evidence based, direct nursing care therefore lies at the centre of all registered nursing practice. In order to respond to the impact and demands of professional nursing practice, they must be emotionally intelligent and resilient individuals, able to manage their own personal health and wellbeing, and know when and how to access support.

Registered nurses may have responsibility for delegating work to other members of the nursing team and take accountability for the delegated activity.

Entry requirements

Prior to commencement apprentices will have their numeracy, literacy and digital skills assessed by the NMC Approved Education Institution to ensure the apprentice has the necessary skills at a minimum of Level 2 to meet the requirements of the programme

Occupation duties

Duty

Criteria for measuring performance

KSBs

Duty 1 Be an accountable professional acting in the best interests of people, putting them first and providing nursing care that is person-centred, safe and compassionate.

In accordance with the The Code – Professional standards of practice and behaviour for nurses and midwives (NMC, 2015)

In line with relevant legislation, procedures and guidelines

K1 K2 K3 K4 K5

S1 S2 S3 S4 S5 S6

B1 B2 B3

Duty 2 Communicate effectively, act as a role models for others and be accountable for their own actions

All communication is accurate, appropriate and in line with relevant legislation, regulation, governance requirements and policies

All records are complete, clear, accurate and timely

K6 K7 K8

S7 S8 S9 S10 S11 S12 S13

B1 B2 B3

Duty 3 Promote health and prevent ill-health to improve and maintain the mental, physical and behavioural health and well-being of people, families, communities and populations.

In line with policies and current best practice

All communication is accurate, appropriate and in line with relevant legislation, regulation, governance requirements and policies

K9 K10 K11 K12 K13

S14 S15 S16 S17 S18 S19 S20 S21

B1 B2 B3

Duty 4 Assess individuals nursing care needs and plan care using information obtained during assessments to identify the priorities and requirements for person-centred and evidence-based nursing interventions and support

Information required to make assessment decisions is accurate, complete and appropriate to the assessment

Assessments undertaken in line with policies and current best practice

Routine investigations undertaken safely and in line with policies and current best practice

Referrals or action required following assessment or routine investigations is in line with policies and current best practice

K14 K15 K16 K17 K18 K19 K20 K21

S22 S23 S24 S25 S26 S27 S28 S29

B1 B2 B3

Duty 5 Provide and evaluate nursing care to individuals and groups taking the lead in providing evidence based, compassionate and safe nursing interventions

All communication is accurate, appropriate and in line with relevant legislation, regulation, governance requirements and policies

Nursing interventions are timely and in line with relevant legislation, regulation, governance requirements and policies

All records are accurate and complete

Calculations are accurate

Speed, accuracy and spatial awareness when using equipment/ devices

Equipment and devices used in accordance with manufacturers instructions

K22 K23 K24 K25 K26 K27 K28 K29 K30 K31 K32 K33 K34

S30 S31 S32 S33 S34 S35 S36 S37 S38 S39 S40

B1 B2 B3

Duty 6 Improve safety of care by assessing risks to safety or experience and take appropriate action to manage those, putting the best interests, needs and preferences of people first

In line with relevant legislation, regulation, governance requirements and policies

Accurately assesses risk to improve safety of care

K35 K36 K37 K38 K39 K40

S41 S42 S43 S44 S45

B1 B2 B3

Duty 7 Improve quality of care by making a key contribution to the continuous monitoring and quality improvement of care and treatment in order to enhance health outcomes and people’s experience of nursing and related care.

In line with relevant legislation, regulation, governance requirements and policies

Actively contributes to continuous improvement and monitoring of care and treatment for people

K41 K42

S46 S47 S48

B1 B2 B3

Duty 8 Provide professional leadership in the coordination and management of complex nursing and integrated care needs of people at any stage of their lives, across a range of organisations and settings

In line with relevant legislation, regulation, governance requirements and policies

Professional leadership in management of complex nursing and needs of people is effective and based on best current nursing practice

K43 K44 K45 K46 K47 K48 K49 K50 K51 K52 K53

S49 S50 S51

B1 B2 B3

Duty 9 Lead nursing care, taking responsibility for managing nursing care and accountability for the appropriate delegation and supervision of care provided by others in the team including lay carers

Manages nursing care in line with relevant legislation, regulation, governance requirements and policies

Delegates appropriately and is accountable for delegating care to others

K54 K55

S52 S53 S54 S55

B1 B2 B3

Duty 10 Work in teams, collaborating and communicating effectively with a range of colleagues

Feedback provided is constructive

All information/ data shared is accurate, appropriate and in line with relevant legislation, regulation, governance requirements and policies

K55 K56 K57 K58

S55 S56 S57 S58

B1 B2 B3

KSBs

Knowledge

K1: Understand the Code (2015): Professional standards of practice and behaviour for nurses and midwives and how to fulfil all registration requirements

K2: Understand the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health

K3: Understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and wellbeing required to meet people’s needs for mental and physical care

K4: Understand research methods, ethics and governance in order to critically analyse, safely use, share and apply research findings to promote and inform best nursing practice

K5: Understand the need to base all decisions regarding care and interventions on people’s needs and preferences, recognising and addressing any personal and external factors that may unduly influence their decisions

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice, differentiating where appropriate between the devolved legislatures of the United Kingdom

K7: Understand the principles of courage, transparency and the professional duty of candour

K8: Understand how discriminatory behaviour is exhibited

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

K10: Understand epidemiology, demography, genomics and the wider determinants of health, illness and wellbeing and apply this to an understanding of global patterns of health and wellbeing outcomes

K11: Understand the factors that may lead to inequalities in health outcomes

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and wellbeing

K17: Understand and apply a person-centred approach to nursing care, demonstrating shared assessment, planning, decision making and goal setting when working with people, their families, communities and populations of all ages

K18: Understand and apply the principles and processes for making reasonable adjustments

K19: Understand and apply the relevant laws about mental capacity for the country in which you are practising when making decisions in relation to people who do not have capacity

K20: Understand co-morbidities and the demands of meeting people’s complex nursing and social care needs when prioritising care plans

K21: Know when and how to refer people safely to other professionals or services for clinical intervention or support

K22: Understand what is important to people and how to use this knowledge to ensure their needs for safety, dignity, privacy, comfort and sleep can be met, acting as a role model for others in providing evidence based person-centred care

K23: Know and understand how to support people with commonly encountered mental health, behavioural, cognitive and learning challenges, and act as a role model for others in providing high quality nursing interventions to meet people’s needs

K24: Know and understand how to support people with commonly encountered physical health conditions, their medication usage and treatments, and act as a role model for others in providing high quality nursing interventions when meeting people’s needs

K25: Know how to act as a role model for others in providing evidence-based nursing care to meet people’s needs related to nutrition, hydration and bladder and bowel health

K26: Know how to act as a role model for others in providing evidence-based, person-centred nursing care to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity

K27: Know how to identify and initiate appropriate interventions to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

K28: Understand what is important to people and their families when providing evidence-based person-centred nursing care at end of life including the care of people who are dying, families, the deceased and the bereaved

K29: Know the signs of deterioration or distress in mental, physical, cognitive and behavioural health and use this knowledge to make sound clinical decisions

K30: Understand how to initiate and evaluate appropriate interventions to support people who show signs of self-harm and/or suicidal ideation

K31: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies and demonstrate proficiency and accuracy when calculating dosages of prescribed medicines

K32: Understand the principles of pharmacology and recognise the effects of medicines, allergies, drug sensitivities, side effects, contraindications, incompatibilities, adverse reactions, prescribing errors and the impact of polypharmacy and over the counter medication usage

K33: Know and understand how prescriptions can be generated, the role of generic, unlicensed, and off-label prescribing and an understanding of the potential risks associated with these approaches to prescribing

K34: Apply knowledge of pharmacology to the care of people, demonstrating the ability to progress to a prescribing qualification following registration

K35: Understand the principles of health and safety legislation and regulations

K37: Understand how to identify, report and critically reflect on near misses, critical incidents, major incidents and serious adverse events in order to learn from them and influence their future practice

K38: Understand the differences between risk aversion and risk management and how to avoid compromising quality of care and health outcomes

K39: Understand and accept the need to accept and manage uncertainty, and demonstrate an understanding of strategies that develop resilience in self and others

K40: Understand the role of registered nurses and other health and care professionals at different levels of experience and seniority when managing and prioritising actions and care in the event of a major incident

K41: Understand the principles of quality improvement methodologies

K42: Understand how the quality and effectiveness of nursing care can be evaluated in practice, work with people, their families, carers and colleagues to develop effective improvement strategies for quality and safety

K43: Understand the principles of partnership, collaboration and interagency working across all relevant sectors

K44: Understand health legislation and current health and social care policies, and the mechanisms involved in influencing policy development and change, differentiating where appropriate between the devolved legislatures of the United Kingdom

K45: Understand the principles of health economics and their relevance to resource allocation in health and social care organisations and other agencies

K46: Understand how current health policy and future policy changes for nursing and other professions and understand the impact of policy changes on the delivery and coordination of care

K47: Understand and recognise the need to respond to the challenges of providing safe, effective and person-centred nursing care for people who have co-morbidities and complex care needs

K49: Understand how to monitor and evaluate the quality of people’s experience of complex care

K50: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives

K51: Understand the principles and processes involved in planning and facilitating the safe discharge and transition of people between caseloads, settings and services

K52: Understand the processes involved in developing a basic business case for additional care funding by applying knowledge of finance, resources and safe staffing levels

K53: Understand the importance of exercising political awareness throughout their career, to maximise the influence and effect of registered nursing on quality of care, patient safety and cost effectiveness

K54: Understand the principles of effective leadership, management, group and organisational dynamics and culture and apply these to team working and decision-making

K55: Understand the principles and application of processes for performance management and how these apply to the nursing team

K56: Understand the roles, responsibilities and scope of practice of all members of the nursing and interdisciplinary team and how to make best use of the contributions of others involved in providing care

K57: Understand and apply the principles of human factors, environmental factors and strength-based approaches when working in teams

K58: Understand the mechanisms that can be used to influence organisational change and public policy, demonstrating the development of political awareness and skills

Skills

S1 Act in accordance with the Code (2015): Professional standards of practice and behaviour for nurses and midwives, and fulfil all registration requirements

S2 Think critically when applying evidence and drawing on experience to make evidence informed decisions in all situations

S3 Use resilience and emotional intelligence and is capable of explaining the rationale that influences judgments and decisions in routine, complex and challenging situations

S4 Take responsibility for continuous self-reflection, seeking and responding to support and feedback to develop their professional knowledge and skills

S5 Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register

S6 Acts as an ambassador, upholding the reputation of their profession and promoting public confidence in nursing, health and care services

S7 Communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges

S8 Support people at all stages of life who are emotionally or physically vulnerable

S11 Report any situations, behaviours or errors that could result in poor care outcomes

S12 Identify and challenge discriminatory behaviour

S13 Contribute effectively and proactively in an interdisciplinary team

S14 Apply the principles of health promotion, protection and improvement and the prevention of ill health when engaging with people

S15 Use all appropriate opportunities, making reasonable adjustments when required, to discuss the impact of smoking, substance and alcohol use, sexual behaviours, diet and exercise on mental, physical and behavioural health and wellbeing, in the context of people’s individual circumstances

S16 Promote and improve mental, physical, behavioural and other health related outcomes by understanding and explaining the principles, practice and evidence-base for health screening programmes

S17 Use up to date approaches to behaviour change to enable people to use their strengths and expertise and make informed choices when managing their own health and making lifestyle adjustments

S18 Use appropriate communication skills and strength based approaches to support and enable people to make informed choices about their care to manage health challenges in order to have satisfying and fulfilling lives within the limitations caused by reduced capability, ill health and disability

S19 Provide information in accessible ways to help people understand and make decisions about their health, life choices, illness and care

S20 Promote health and prevent ill health by understanding and explaining to people the principles of pathogenesis, immunology and the evidence-base for immunisation, vaccination and herd immunity

S21 Protect health through understanding and applying the principles of infection prevention and control, including communicable disease surveillance and antimicrobial stewardship and resistance

S28 Identify and assess the needs of people and families for care at the end of life, including requirements for palliative care and decision making related to their treatment and care preferences

S29 Work in partnership with people, families and carers to continuously monitor, evaluate and reassess the effectiveness of all agreed nursing care plans and care, sharing decision making and readjusting agreed goals, documenting progress and decisions made

S30 Support people with commonly encountered mental health, behavioural, cognitive and learning challenges, and act as a role model for others in providing high quality nursing interventions to meet people’s needs

S31 Support people with commonly encountered physical health conditions, their medication usage and treatments, and act as a role model for others in providing high quality nursing interventions when meeting people’s needs

S32 Act as a role model for others in providing evidence-based nursing care to meet people’s needs related to nutrition, hydration and bladder and bowel health

S34 Identify and initiate appropriate interventions to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain

S35 Prioritise what is important to people and their families when providing evidence-based person-centred nursing care at end of life including the care of people who are dying, families, the deceased and the bereaved

S36 Respond proactively and promptly to signs of deterioration or distress in mental, physical, cognitive and behavioural health and use this knowledge to make sound clinical decisions

S47 Use service delivery evaluation and audit findings to bring about continuous improvement

S48 Share feedback and learning from positive outcomes and experiences, mistakes and adverse outcomes and experiences

S49 Facilitate equitable access to healthcare for people who are vulnerable or have a disability

S50 Advocate on behalf of people who are vulnerable or have a disability when required, and make necessary reasonable adjustments to the assessment, planning and delivery of their care

S51 Identify and manage risks and take proactive measures to improve the quality of care and services when needed

S52 Safely and effectively lead and manage the nursing care of a group of people, demonstrating appropriate prioritisation, delegation and assignment of care responsibilities to others involved in providing care

S53 Guide, support and motivate individuals and interact confidently with other members of the care team

S54 Monitor and evaluate the quality of care delivered by others in the team and lay carers

S55 Support and supervise students in the delivery of nursing care, promoting reflection and providing constructive feedback, and evaluating and documenting their performance

S56 Challenge and provide feedback about care delivered by others in the team, and support them to identify and agree individual learning needs

S57 Contributes to supervision and team reflection activities to promote improvements in practice and services

S58 Use a range of digital technologies to access, input, share and apply information and data within teams and between agencies

Behaviour

B1: Treat people with dignity, respecting individual's diversity, beliefs, culture, needs, values, privacy and preferencesB2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practiceB3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness and demonstrate leadership

Qualifications

English and Maths qualifications

Apprentices without level 2 English and maths will need to achieve this level prior to taking the End-Point Assessment. For those with an education, health and care plan or a legacy statement, the apprenticeship’s English and maths minimum requirement is Entry Level 3. A British Sign Language (BSL) qualification is an alternative to the English qualification for those whose primary language is BSL.

Other qualifications

Mandatory qualification 1: Degree in Nursing or L7 qualification approved by the NMC where the apprentice already holds a Level 6 degree

Level of qualification: 6

Basis for mandatory qualification: Regulatory requirement

Mandatory qualification 2: Degree in Nursing or L7 qualification approved by the NMC where the apprentice already holds a Level 6 degree